Part One - Doctorswriting



Part One

Pharmacology

Mock

MCQ Examination

60 Questions

90 minutes exam time

1. Which of the following benzodiazepines has the shortest elimination half life?

a. Lorazepam

b. Diazepam

c. Triazolam

d. Temazepan

e. Alprazolam

2. You are given a vial with 15ml of 0.5% prilocaine to do an arm block. How many mg of prilocaine are you injecting?

a. 7.5mg

b. 15mg

c. 30mg

d. 50mg

e. 75mg

3. The inhaled general anaesthetic with the highest blood gas partition coefficient is:

a. Methoxyflurane

b. Seroflurane

c. Nitrous oxide

d. Isoflurane

e. Halothane

4. Regarding local anaesthetic agents

a. Lignocaine is also an antiarrhythmic of the Vaughan Williams group 1A classification.

b. At normal tissue pH the larger function of local anaesthetic in the body fluids will be in the uncharged form.

c. Bupivacaine may cause an apparent cyanosis in some patients.

d. The duration of action of procaine will be increased in the presence of liver disease.

e. Local anaesthetic agents block conduction in small myelinated axons prior to blockade of other axons.

5. Regarding opiate analgesic agents

a. Codeine has a low oral:parenteral potency.

b. Most opioids are metabolised in the liver to polar metabolites.

c. Kappa opioid receptors are responsible for the respiratory depressant properties of morphine.

d. Miosis is one action of opioids to which tolerance develops.

e. The usual dose of naloxone is 1-4mg IV repeated as necessary.

6. All of the following may occur with marijuana except

a. Miosis

b. Increased pulse rate

c. Tremor

d. Reddened conjunctivae

e. Decreased blood pressure

7. Suxamethonium

a. Is a nondepolarising neuromuscular blocking agent.

b. Is contraindicated in all eye operations.

c. Stimulates cardiac muscarinic receptors and autonomic ganglia.

d. Its action is directly terminated by the action of plasma cholinesterase.

e. Should not be administered to patients with burns >24 hours old because of its hypercalcaemic effect.

8. Inhalational anaesthetics

a. Enflurane is proconvulsant.

b. Isoflurane is the inhalational agent of choice in patients with active ischaemic heart disease.

c. Nitrous oxide is a useful adjunct to volatile anaesthetic use in women in the first trimester of pregnancy.

d. Halothane has a MAC of 0.75% - making it less potent than desflurane.

e. Desflurane is extensively metabolised via the liver.

9. Phenytoin

a. Is 20-30% bound to albumin.

b. Is the drug of choice in treatment of absence seizures.

c. Undergoes flow limited elimination.

d. Steady state mean plasma concentration varies disproportionately with the dose.

e. Preferentially binds to activated state sodium channels.

10. Regarding drugs used in Parkinson’s disease

a. Bromocriptine is the first line drug to treat Parkinson’s disease in psychotic patients.

b. 80-90% of a single dose of Levodopa enters the brain unaltered

c. Patients taking selegiline to treat Parkinson’s disease are limited in what they can eat because of the tyramine reaction phenomenon.

d. Amantadine has anti Parkinsonian effects and is administered at a dose of 100mg twice a day.

e. Antimuscarinic drugs are of benefit in elimination of bradykinesia in Parkinson’s.

11. Which of the following antipsychotics (in excess dose) is responsible for cardiac arrhythmias?

a. Chlorpromazine

b. Thiothixene

c. Thioridazine

d. Haloperidol

e. Clozapine

12. Regarding the penicillins

a. Penicillin is excreted into breast milk to levels 3-15% of those present in the serum.

b. Absorption of amoxyl is impaired by food.

c. Benzathine penicillin is given orally.

d. Penicillins are 90% excreted by glomerular filtration.

e. Dosage of nafcillin should be adjusted in the presence of renal failure.

13. All of the following antibiotics bind to the 5OS subunit of the ribosome therefore inhibiting protein synthesis except

a. Chloramphenicol

b. Doxycycline

c. Erythromycin

d. Linezolid

e. Clindamycin

14. Regarding the pharmacokinetics of the tetracyclines

a. Tetracyclines are 40-80% bound by serum proteins.

b. Absorption is enhanced by coadministration of antacids.

c. Tetracyclines cross the BBB easily.

d. Doxycycline is excreted predominantly via the kidney.

e. Demeclocycline is a short acting tetracycline drug.

15. Regarding fluoroquinolones

a. Ciprofloxacin is ineffective in the treatment of gonococcus.

b. Norfloxacin and Ciprofloxacin are predominantly faecally excreted.

c. Norfloxacin and Ciprofloxacin have long half lives (12 hours).

d. They have poor oral bioavailability.

e. May damage growing cartilage in children less than 18 years of age.

16. All of the following are recognised adverse effects of isoniazid except

a. Hepatitis

b. Peripheral neuropathy

c. Retrobulbar neuritis

d. ( phenytoin metabolism - ( protein blood levels and toxicity

e. CNS toxicity

17. Regarding antifungals – all of the following pairings are correct except

a. Ketoconazole = inhibition of cytochrome P450 enzymes.

b. Fluconazole = good CSF penetration

c. Amphotericin B = renal impairment

d. Griseofulvin = insoluble, derived from species of penicillin

e. Nystatin = useful IV antifungal agent

18. We use antiretroviral agents in ED every day .... NOT! But here is a question on them anyway

a. Lamivudine is active against the hepatitis B virus

b. Didanosine may cause pancreatitis

c. Zidovudine has neutropaenia and anaemia as side effects

d. Ritonavir is a protease inhibitor

e. All of the above are correct

19. Drugs which enhance other drug metabolism include all of the following except

a. Rifampicin

b. Ketoconazole

c. Phenobarbitol

d. Griseofulvin

e. Phenytoin

20. Which of the following has a high extraction ratio?

a. Trimethoprim

v. Valproic acid

c. Lignocaine

d. Metronidazole

e. Diazepam

21. Which of the following has the greatest apparent volume of distribution?

a. Frusemide

b. Lithium

c. Nortriptylline

d. Chloroquine

e. Propranolol

22. Heparin and protamine used together is an example of

a. Physiologic antagonism

b. Chemical antagonism

c. Partial agonism

d. Irreversible antagonism

e. Agonal agonism

23. The half life of a drug with a Vd of –200L/70kg and clearance of 10ℓ/hr/70kg is:

a. 10 hours

b. 14 hours

c. 20 hours

d. 40 hours

e. indeterminate

24. Acetaminiophen (paracetamol) can undergo all of the following biotransformation reactions except

a. Deamination

b. N-oxidation

c. Glucuronidation

d. Sulphation

e. Glutathione conjugation

25. Atropine

a. Is a quaternary amine alkaloid ester of tropic acid.

b. About 60% of the dose of atropine is excreted unchanged in the urine.

c. Atropine has prominent stimulant CNS effects when given in usual doses.

d. Causes irreversible blockade of the actions of cholinomimetics at muscarinic receptors.

e. Causes diarrhoea.

26. Regarding sympathomimetic drugs

a. Amphetamine is a powerful stimulant of appetite.

b. Phenylephrine effectively causes miosis.

c. Ephedrine acts primarily through the release of stored catecholamines.

d. Dobutamine is a B2 selective agent.

e. Cocaine works by inhibiting GABA reuptake into neurons in the “pleasure centres” of the brain.

27. B blockers have many different properties. Which of the following statements is correct?

a. Atenolol has high lipid solubility.

b. Esmolol has partial agonist activity.

c. Labetalol is B1 selective.

d. The elimination half life of sotalol is 12 hours.

e. Timolol has prominent local anaesthetic activity.

28. Regarding the ACE inhibitors

a. Captopril is a prodrug

b. They stimulate the renin angiotensin system and inhibit the kallikrein kinin system

c. They are safe in pregnancy

d. Enalapril should be given at least 3 times a day

e. They can be used safely in persons with ischaemic heart disease

29. Which of the following drugs is most extensively bound to plasma proteins?

a. Morphine

b. Gentamicin

c. Warfarin

d. Carbamazepine

e. Theophylline

30. Nitrates are used in ED often. Which of the following statements is correct?

a. Arteries are more sensitive to relaxant effects of nitroglycerin than veins.

b. Nitrates are absolutely contraindicated in patients with glaucoma.

c. Nitroglycerin works by being denitrated – thus releasing nitrate ion which vasodilates.

d. The duration of action of isosorbide dinitrate (oral) is 10-60 minutes.

e. Smooth muscle can develop tachy phylaxis to nitrates.

31. Examples of vaccines using live agents include all of the following except

a. Smallpox

b. Influenza

c. Mumps

d. Measles

e. Yellow fever

32. Regarding calcium channel blockers and treatment of angina pectoris

a. Nifedipine is selective for cerebral blood vessels.

b. Verapamil is 70% eliminated by the GI tract.

c. Diltiazem has a greater ratio of smooth muscle effects relative to cardiac effects than amlodipine does.

d. Nimodipine has the shortest half life of all the calcium channel blockers.

e. Ca2+ channel blockers also have a skeletal muscle depressant effect.

33. Digoxin has all of the following actions on cardiac electrical function except

a. ( atrial muscle automaticity

b. ( AV node conduction velocity

c. ( refractory period in perkinge system and ventricles

d. ST segment depression on ECG – especially with chronic use

e. Bigeminy can occur

34. Toxicity of digoxin may be exacerbated by which of the following

a. Hypocalcaemia

b. Hyperkalaemia

c. Hypomagnesaemia

d. Hyperuricaemia

e. Grapefruit juice

35. Which of the following pairings is correct?

a. Quinidine – can shorten QT interval on the ECG by shortening the action potential duration.

b. Procainamide – adverse effect = SLE like syndrome.

c. Lignocaine – Vaughan Williams class 1C drug.

d. Flecainide – prominent antimuscarinic effects.

e. Sotalol – extensively metabolised in the liver.

36. Amiodarone (oral)

a. Has a half life of 5 days

b. Increases clearance of Warfarin, Theophylline and other drugs.

c. Has a high affinity for activated sodium channels.

d. Causes torsades de pointes frequently because of prolongation of the QT interval.

e. Causes photodermatitis in about 25% of patients.

37. Glucagon

a. In large doses produces profound relaxation of the intestine.

b. Is a potent negative inotrope/chronotrope.

c. Serves to raise blood glucose at the expense of skeletal muscle glucagon.

d. Has multiple severe adverse reactions.

e. Therapeutic doses used to reverse hypoglycaemia are 10mg.

38. Regarding sulfonylureas

a. They increase insulin release from the pancreas by inhibition of sodium ion influx.

b. They also stimulate insulin synthesis.

c. Tolbutamide is a second generation drug which should be used with caution in elderly diabetics.

d. Glipizide therapy is contraindicated in patients with significant hepatic impairment.

e. Chlorpropamide has the shortest half life of all the sulfonylureas.

39. Which of the following corticosteroids has the greatest anti-inflammatory potency relative to hydrocortisone?

a. Prednisone

b. Cortisone

c. Fludrocortisone

d. Triamcinolone

e. Betamethasone

40. Regarding antithyroid drugs

a. Propylthiouracil blocks uptake of iodide by the thyroid gland.

b. Radioactive iodine is safe in breast feeding mothers.

c. Lithium may cause inhibition of thyroid hormone synthesis or release.

d. The cross sensitivity between propylthiouracil and methimazole is about 10%.

e. Adverse reactions to iodine are very common.

41. Heparin

a. Is a heterogeneous mixture of sulfated fatty acids.

b. Heparin binds to antithrombin and accelerates reactions between antithrombin and clotting factor proteases 100 fold.

c. Heparin causes severe thrombocytopaenia in 10% of patients.

d. Heparin crosses the placenta easily and thus should not be used in pregnancy.

e. Long term use of heparin is associated with mineralocorticoid deficiency.

42. All of the following may interact with Warfarin to increase prothombin time except

a. Amiodarone

b. Cholestyramine

c. Fluconazole

d. Cimetidine

e. Disulfiram

43. Regarding aspirin

a. It irreversibly acetylates and blocks platelet cyclooxygenase.

b. Salicylism occurs at aspirin plasma concentrations of 10mg/dl.

c. Is now completely safe in children as Reye’s syndrome is a myth.

d. Aspirin in doses of 4g or more per day will elevate uric acid levels.

e. It is very effective for relief of severe visceral pain.

44. The nonsteroidal anti inflammatory drug with the longest half life is

a. Naproxen

b. Aspirin

c. Ibuprofen

d. Diclofenac

e. Piroxicam

45. Regarding the methylxanthines

a. At high concentration these drugs stimulate the enzyme phosphodiesterase.

b. They have antidiuretic action.

c. Tolerance to the bronchodilating effects of theophylline may develop.

d. Improvement in pulmonary function is correlated with plasma theophylline concentration of 5-20mg/ℓ.

e. Neonates clear theophylline from the body faster than adults.

46. Regarding acetazolamide

a. 85% of the bicarbonate resorptive capacity is inhibited by acetazolamide in the proximal tubule.

b. Hyperchloraemic metabolic alkalosis may result from acetazolamide administration.

c. Is safe to use in patients with hepatic disease as it is eliminated renally.

d. It decreases phosphate excretion in the kidney.

e. Renal excretion of weak bases is enhanced by acetazolamide.

47. Loop diuretics

a. Consist of spironolactone and bendrofluazide.

b. Inhibit the Na+ K+ / 2 Cl- transport pump in the distal tubule of the kidney.

c. Can cause a usually irreversible ototoxic reaction.

d. Can cause hyperuricaemia and precipitate gout.

e. Inhibit renal prostaglandin synthesis.

48. Thiazides can cause all of the following entities except

a. Hyponatraemia

b. Hyperuricaemia

c. Hypocalcaemia

d. Hyperlipidaemia

e. Metabolic alkalosis

49. Regarding H1 blockers

a. 1st generation H1 blockers are nonsedating agents.

b. Promethazine is more potent than procaine as a local anaesthetic.

c. Interaction of some 2nd generation H1 blockers with tomato juice can increase the drug levels leading to torsade de pointes.

d. Cyproheptadine has prominent blocking effects at dopamine receptors as well as being a potent H1 blocker.

e. Loratadine has a short half life of 2 – 4 hours.

50. Which of the following statements is correct

a. Sumatriptan = 5HT1A agonist

b. Buspirone = 5HT1D agonist

c. Cisapride = 5HT4 agonist

d. Ketanserin = 5HT3 agonist

e. Ondansetron = 5HT1C agonist

51. Regarding uses of antibiotics – which of the following statements is true?

a. Shigella – treat with a quinolone.

b. Chlamydia psittaci – treat with a tetracycline.

c. Legionella – treat with Erythromycin.

d. Clostridium difficile – treat with metronidazole.

e. All of the above are correct.

52. All of the following drugs have different oral drug absorption rates in the neonate except

a. Phenytoin

b. Acetaminophen

c. Ampicillin

d. Phenobarbital

e. Digoxin

53. One of the following drugs is not affected by age related decrease in hepatic clearance. Which one is it?

a. Lignocaine

b. Diazepam

c. Propranolol

d. Theophylline

e. Imipramine

54. Metoclopramide

a. Is a dopamine agonist

b. Is a prokinetic agent in the gut

c. Increases gastric secretions

d. Releases adrenaline from neurons in the enteric nervous system’s myenteric plexus

e. Has a half life of 8 hours – so is given 3 x per day

55. All of the following may be seen in the classic anticholinergic syndrome except

a. Flushed skin

b. Dilated pupils

c. Hypothermia

d. Confusion

e. Dry mucous membranes

56. Tardine dyskinesia

a. Is an acute dystonic reaction

b. Is secondary to a relative cholinergic excess

c. Older men on chronic antipsychotic treatment are most susceptible to this problem

d. Is sometimes self limited

e. Is estimated to occur in 60% of chronically treated patients

57. Plasma lithium levels (assuming no change in daily lithium dose) may become toxic in the presence of all of the following except

a. Post partum state

b. Dehydration

c. Use of some non steroidal anti inflammatory drugs

d. Use of thiazides

e. Pregnancy

58. Regarding IV anaesthetic agents

a. Ketamine is the induction agent of choice in a head injured patient

b. Propofol has a slow offset of action.

c. Etomidate causes hypotension more commonly than thiopentone.

d. Ideal agents for neuroleptanaesthesia are fentanyl and droperidol.

e. Thiopentone is metabolised at a rate of 40-50% per hour in humans following a single dose.

59. Regarding the alcohols – which I would image you will drink heaps of once the exam is over –

a. Formaldehyde is responsible for the toxic effects of methanol.

b. Alcohols can cause a wide anion gap metabolic acidosis.

c. A normal nontolerant adult can metabolise 30-40 grams of alcohol/hour.

d. Ethanol is a potent vasoconstrictor.

e. The volume of distribution of ethanol is 3ℓ/kg.

60. The study of pharmacokinetics is

a. What the drug does to the body

b. Really, really interesting

c. What the body does to the drug

d. Incredibly boring

e. Related to neuroleptokinetics

Pharmacology Answers

1. C

2. E

3. A

4. E

5. A

6. A

7. C

8. D

9. D

10. D

11. C

12. A

13. B

14. A

15. E

16. C

17. E

18. E

19. B

20. C

21. D

22. B

23. B

24. A

25. B

26. C

27. D

28. E

29. C

30. E

31. B

32. D

33. A

34. C

35. B

36. E

37. A

38. D

39. E

40. C

41. E

42. B

43. A

44. E

45. D

46. A

47. D

48. C

49. B

50. C

51. E

52. E

53. A

54. B

55. C

56. D

57. E

58. D

59. B

60. C

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